Download Bridion (sugammadex)

New Drug Introduction: Bridion/sugammadex
Pharmacology
Manufacturer
Approval Date
Indications
Contraindications
Black Box Warnings
Warnings &
Precautions
Pregnancy/Lactation
Pharmacokinetics
Drug Interactions –
Precipitant/Object
Adverse Effects
(Treatment%)
Monitoring Efficacy
Dosing – Usual
Dosing - Emergent
Renal Adjustment
Hepatic Adjustment
Cyclodextrin that forms a 1:1 complex with vecuronium and
rocuronium
Merck
December 15, 2015
Used for adults undergoing general surgery for the reversal of
neuromuscular blockade induced by vecuronium or rocuronium
Hypersensitivity to sugammadex or any component of the product
None
Use not recommended with severe renal impairment or dialysisdependent patients
Pregnancy: no adequate or well-controlled studies in pregnant women
Lactation: Unknown if excreted in human breast milk
A – T1/2: 2 hours
D – Vd: 11-14L, no protein binding
M – No metabolites
E – Renal: 96%
Hormonal contraceptives: must recommend additional, non-hormonal
method of contraception for 7 days after administration.
Sugammadex binds to progestogen component and decreases serum
hormone levels.
Nausea (23-26%)
Bradycardia (1-5%)
Vomiting (11-15%)
Prolonged QT interval (up to 6%)
Headache (5-10%)
Anaphylaxis (0.5%)
Reversal of neuromuscular blockade
Twitch responses and spontaneous recovery
2-4 mg/kg IV bolus based on total body weight and dosing is guided
by blockade status
16 mg/kg IV bolus based on total body weight
No adjustment needed; Not recommended in severe renal impairment
or dialysis-dependent patients
No adjustment needed
Cost: Source: Lexicomp 4/5/16
Vial Size
Drug
Bridion (sugammadex)
200 mg/2ml SDV
500 mg/5ml SDV
Bloxiverz (neostigmine)
1 mg/ml 10 ml MDV
Robinul (glycopyrrolate)
0.2 mg/ml SDV
AWP Pricing
$1140
$2088
$1185
$390
Summary
 Bridion, sugammadex, is first-in-class cyclodextrin that directly reverses neuromuscular
blockade and offers signifcantly faster recovery times compared to neostigmine
 It is indicated for the reversal of neuromuscular blockade for rocuronium and
vecuronium for patients undergoing surgical procedures
 It is administered 2-4 mg/kg IV bolus based on total body weight OR 16 mg/kg IV bolus
reserved for emergent reversal
 Sugammadex has a significant drug-drug interaction that decreases the efficacy of
hormonal contraceptives. All women of child-bearing age should be counseled on
using a backup method of contraception for 7 days post-op.
 Common side effects include; nausea, vomiting and headache.
 Patients should be monitored closely for bradycardia and anaphylaxis during
procedure and recovery.
References:
1. www.bridion.com
2. Bridion package insert. Merck. Dec. 2015.
3. Blobner M, Eriksson L, Scholz J, Hillebrand H, Pompei L. Sugammadex (2.0 mg/kg)
significantly faster reverses shallow rocuronium-induced neuromuscular blockade
compared with neostigmine (50 µg/kg). Eur J Anaesthesiol 2001;18:99.
Date Prepared: April 5, 2016
Editor: Peter G. Koval, Pharm.D., BCPS
Author: Michael Rollins, Pharm.D. Candidate, UNC Eshelman School of Pharmacy